ICD-10 Coding for Migraine Cephalalgia(G43.E11, G43.109)
Complete ICD-10-CM coding and documentation guide for Migraine Cephalalgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Migraine Cephalalgia
G43Primary Range
Migraine
This range includes all types of migraines, including those with aura, chronic, and intractable forms.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G43.E11 | Chronic migraine with aura, intractable, with status migrainosus | Use when the patient has chronic migraine with aura, is intractable, and has status migrainosus. |
|
| G43.109 | Migraine with aura, not intractable, without status migrainosus | Use for episodic migraines with aura that are not intractable. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for chronic migraine with aura
Essential facts and insights about Migraine Cephalalgia
Primary ICD-10-CM Codes for migraine cephalalgia
Decision Criteria
clinical Criteria
- Patient reports ≥15 headache days/month with aura symptoms.
documentation Criteria
- Documented failed treatments and headache duration >72hrs.
Applicable To
- Chronic migraine with aura
- Intractable migraine
- Status migrainosus
Excludes
- Tension-type headache (G44.2)
Clinical Validation Requirements
- ≥15 headache days/month for 3+ months
- Aura symptoms documented
- Failed ≥2 treatments
- Headache >72hrs
Code-Specific Risks
- Incorrectly coding as unspecified migraine
- Missing documentation of frequency or treatment failures
Coding Notes
- Ensure documentation specifies frequency, aura, and treatment response.
G43.109 - Migraine with aura, not intractable, without status migrainosus
Use for episodic migraines with aura that are not intractable.
Applicable To
- Episodic migraine with aura
Excludes
- Chronic migraine (G43.E-)
Clinical Validation Requirements
- Episodic (<15 days/month)
- Aura symptoms documented
Coding Notes
Ensure aura symptoms are clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Mental and behavioral disorders due to psychoactive substance use
F11-F19Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Migraine Cephalalgia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.E11.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Increases risk of coding audits., Financial: Potential for denied claims.
Mitigation Strategy
Train staff on documentation requirements., Use templates to ensure completeness.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Always document and code specific migraine types, such as chronic or with aura.
Impact
Lack of specific frequency documentation can lead to audit failures.
Mitigation Strategy
Implement regular documentation audits and training.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Migraine Cephalalgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Migraine Cephalalgia
Use these documentation templates to ensure complete and accurate documentation for Migraine Cephalalgia. These templates include all required elements for proper coding and billing.
Chronic Migraine with Aura
Specialty: NeurologyRequired Elements
- Headache frequency
- Aura symptoms
- Treatment responses
- Associated symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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